421 Closed loop analgesia audit, a Single Centre Experience in Raigmore Hospital, Inverness, Scotland

Abstract

Abstract Aim Assess are we following the analgesic step ladder accurately and if not are the reasons clear and documented? Method A closed-loop audit performed on the use of the WHO Analgesic ladder in surgical patients. We looked at the compliance of the analgesic ladder and are the reasons documented or explained when the ladder is not followed. The data was collated, analysed, and presented at an audit meeting. We then implemented changes in the form of educational sessions and information leaflets sharing, as well as email reminders among staff. Post-implementation showed an improvement in the documentation when the analgesic ladder was not followed. Results A total of 103 surgical patients were included. Prior to the implementation of interventions, 83.3% of patients had analgesia prescribed following the analgesic ladder. Of those remaining patients who had analgesia prescribed not according to the analgesic ladder, only 50% documented the indications and reasons. Post-implementation, the analgesic ladder compliance dropped to 50.9% with documentation improvement to 56%. Conclusions All surgical patients have prescribed analgesia when needed. Though WHO ladder compliance has shown reduction compared to the first data sample, the reasons are clinically justified, and improvements have been shown in documentation after intervention though there is still room for improvement for documentation. This is perhaps surgical teams are more aware of the choice of analgesia used post-intervention while taking the analgesic ladder into consideration. Stepwise multimodal analgesia prescribing will improve analgesic effect hence improves post-operative recovery hence reduce the length of hospital stay as part of the ERAS protocol.